60: “Percent of the time…it works…EVERY time,” or so said Paul Rudd’s news character in Anchorman about his potent cologne, which Ron Burgundy sternly replied in a way that only Will Ferrell can, “Well that just doesn’t make sense” – which is of course logical and funny to say out loud, but Rudd’s stat isn’t so illogical if you think about it. In baseball, 60% gets you in the Hall of Fame, in high school it gets you a diploma and in healthcare it can get you “coverage” for novel treatments and increasingly that better-than-half goal will be part of more and more outcomes-based contracts, particularly for specialty pharmaceuticals that are high cost, like $30,000 or $100,000 a treatment, and even in contracts for physician specialists who can get 60% of high-cost patients to goal faster than peers.
Wal-Mart Charting New Ground: The company classifies specified surgeries performed outside of a center of excellence facility as out-of-network care and covers only 50% of the cost in most cases, according to a benefit design director for the retailer. The company has found impressive results from the care provided at their centers of excellence – including a one-day shorter average length of stay for spine and joint replacement surgery, a big drop in discharges to SNFs for surgical patients – 6 out of every 1,000 for spine patients using centers of excellence vs. 49 out of 100 at other providers, and up to a 3-week shorter period of time off. Additionally, about 50% of patients who went to these COEs never actually underwent surgery because providers told them they didn’t need it.
Unpaid Value Contract: A care coordination company in Urbana, Illinois got a $420 per member per month back in 2017 for managing at-risk youth from a state pilot program, incentives up to 15% of the dollars if hitting 5 cost targets while a Medicaid managed care plan in Kansas paid a family guidance center in Topeka a $20 PMPM for each high-risk patient seen in person, $1 PMPM for following-up with members after 7 days, $1.50 PMPM for eliminating adverse events, $80 for a medication review and other payments for managing youth with a mix of acute behavioral and diabetic conditions. These were some of the first programs to get creative around paying to reduce social costs, but there are lessons to learn from these reforms, namely that the providers had to do a lot of patient outreach and data collection and reporting that wasn’t reimbursed. Make sure to consider this when negotiating value-based contracts.
Like A Game Of Risk: If you’re not partnered with GuideWell, you might want to be. The parent company of Florida BCBS is gaining ground in the south, akin to the way Highmark is gaining in the north. It’s like a game of RISK, both because GuideWell plans to acquire Triple S Management, the BCBS plan in Puerto Rico, the largest health insurer in the territory, giving them 1M more lives, and because recent acquisitions of behavioral health management company New Directions and primary care company Sanitas Medical are indicators that Guidewell is looking to create an integrated risk-taking platform.
Drone Drop: More COVID-19 vaccines may be coming your way, courtesy of UPS Flight Forward, which completed the first drone delivery of COVID-19 vaccines last week to Atrium Health Wake Forest Baptist in North Carolina. The delivery went from the hospital to one of the health system's family medicine practices, about half a mile away. The drone can carry 25 vials each, for a total of 450 doses.
Run Run Run, As Fast As You Can: In my mind there are 5 famous gingers – Rodgers, Ale, Snap, the comedic beauty from Gilligan’s Island and, of course, the gingerbread man, but now there’s a new Ginger on the rise making headway in treating the fast moving mental health crisis. The on-demand mental health coaching and video visit company “Ginger” gives people access to therapists and psychiatrists and has merged with the meditation and mindfulness app Headspace to form a new company. Headspace Health will cover nearly 100 million lives through more than 2,700 employer and health plan customers, plus a direct-to-consumer business.
BurnOut App: Trinity Health is collaborating with Pennsylvania insurer Independence BCBS on a digital and clinical program to help support healthcare workers, many of whom are struggling to look after themselves while continuing to look after COVID-19 patients. The program will address clinical burnout using a self-guided care approach and personalized tools created by NeuroFlow, a mental health software company based in Philadelphia. An app allows nurses to journal and log daily insights and a clinical care team remotely monitors data.
Digital Ups & Downs: In a cautionary tale for digital health, the insurer Medica has decided to discontinue a digital pregnancy and fertility program from Ovia Health due to low utilization. This is part of the challenge going forward for tele and digital programs – payers like them, so do patients – in theory - but there’s a time to ROI, and if you’re not getting uptake the “potential” savings mean little and the program’s become merely a cost. The insurer will, however, start giving members access to Optum’s chiropractic network in 2022. The changes impact individual and family members.
Alzheimer’s Spike: In our poll of the week, nearly 4 in 10 expect an increase in patients with Alzheimer’s disease or early on-set Alzheimer’s due to COVID-19. The Alzheimer’s Association recently reported a link between COVID-19 and the neurological condition. A majority say it’s too early to know: “Patients have a temporary loss or impairment in some cases….but no way to predict if that is permanent.”
MusicMan: If healthcare specialists were assigned a single song, an anthem if you will to define their work and their value, I wonder if OBGYNs would choose Mamma Mia or if allergists would pick Annie Lenox’s Every Breath You Take. Songs matter in healthcare more than you think – they help people recover from illness and have proven at times to reduce the cost of medications, and now there are some interesting developments in coverage of music therapy, which to date has been sparsely covered. Stay tuned for the news and our Top 20 rankings of songs for specialists.
ExtraPoint: There are quite a few things that make us feel old. It starts when your kids stop believing in Santa and gets worse when they start wearing your pants, head off to college, then turn 20. Healthcare has its own aging milestones, like when that Medicare ID card comes in the mail or when you have to turn up the TV so loud the neighbors call the police. I’m having my own bouts with oldness, like getting to enjoy that really tasty colonoscopy prep drink or having to force the parents to drink their juice, or realizing you miss the times when you and dad shared the sports page and a spoon full of sugar over Raisin Bran. There are good milestones, like you can dominate athletic competitions like Izzy Mandelbaum did at Del Boca Vista in Seinfeld, or you can eat the early bird supper at 430 and still have time to work off the cheese cake. There’s also the grandkids. You can hold ‘em, burp ‘em and spoil ‘em, and when they start to kick and scream because you gave them cake for breakfast, you can go home. -BC